Workplace Learning Theory Research Articles

Ownership of Patient Care: Medical Students’ Expectations, Experiences, and Evolutions Across the Core Clerkship Curriculum

Phenomenon : Ownership of patient care is a key element of professional growth and professional identity formation, but its development among medical students is incompletely understood. Specifically, how attitudes surrounding ownership of patient care develop, what experiences are most influential in shaping them, and how educators can best support this growth are not well known. Therefore, we studied the longitudinal progression of ownership definitions and experiences in medical students across their core clerkship curriculum. Approach : We conducted a series of four longitudinal focus groups with the same cohort of medical students across their core clerkship curriculum. Using workplace learning theory as a sensitizing concept, we conducted semi-structured interviews to explore how definitions, experiences, and influencers of ownership developed and evolved. Results were analyzed inductively using thematic analysis. Findings : Fifteen students participated in four focus groups spanning their core clerkship curriculum. We constructed four themes from responses: (1) students’ definitions of ownership of patient care evolved to include more central roles for themselves and more defined limitations; (2) student conceptions of patient care ownership became more relational and reciprocal over time as they ascribed a more active role to patients; (3) student assessment fostered ownership as an external motivator when it explicitly addressed ownership, but detracted from ownership if it removed students from patient care; and (4) structural and logistical factors impacted students’ ability to display patient care ownership. Insights : Student conceptions of ownership evolved over their core clerkship curriculum to include more patient care responsibility and more meaningful relational connections with patients, including recognizing patients’ agency in this relationship. This progression was contingent on interactions with real patients and students being afforded opportunities to play a meaningful role in their care. Rotation structures and assessment processes are key influencers of care ownership that merit further study, as well as the voice of patients themselves in these relationships.

Vocational teachers’ perceptions on workplace learning in facilitating students’ professional engagement in the context of industry-university collaboration in China

PurposeThis study aims to explore vocational teachers' perceptions regarding workplace learning that align with students' training models and collaborative teaching involving specialised professionals within the context of industry-university collaboration.Design/methodology/approachUsing a qualitative approach, the study conducted nine semi-structured interviews from three subject areas to better understand how vocational teachers’ work-based learning enhances their pedagogical practice in guiding students’ professional training. Thematic analysis was adopted to identify patterns that emerged from concepts and theories related to coding categories.FindingsThe authors identified three key components: vocational teachers’ workplace learning in connection with students’ training models, collaborative teaching with specialised professionals and teachers’ regular interactions with enterprises. The findings demonstrate that vocational teachers’ engagement in workplace learning pertaining to specific subjects provides a valuable avenue for enhancing curriculum design with collaboration with industry experts. This is key for supporting vocational students’ transitions into the workplace and ensuring their knowledge and skills are tailored to the industry-standard practice.Research limitations/implicationsThe data are limited to the review of interviews from three vocational subject areas as the representative sector in the study. However, this research implies effective knowledge transfer between workplace settings and vocational institutions, and vocational teachers need to integrate work-based vocational knowledge and skills in a relevant and applicable way across diverse classroom settings.Practical implicationsFostering collaborative partnerships with local industries and professionals can be a primary way to facilitate authentic learning experiences that are linked to a specific vocational field and bridge the gap between diverse classroom learning and real-world work scenarios.Originality/valueThis study combines contemporary workplace learning theories with the conceptual understanding of vocational teachers’ involvement with industry-specific practice. Connecting teachers’ knowledge to the industry extends the input and collaboration from professionals and field experts to the diverse vocational classrooms.

Workplace learning for the disadvantaged: Perspectives from adult education and human resource development

AbstractAlong with the rapidly changing social and economic context accompanied by COVID‐19, concerns have been raised for the less‐educated, low‐wage workers who disproportionately experienced disadvantages in accessing workplace learning or training opportunities essential for job placement or career development. In response to the challenges of increasing discrepancies in workplace learning opportunities, this paper suggested workplace learning as an area that needs more attention from multidisciplinary perspectives to support the needs of disadvantaged populations. The authors reviewed research trends on workplace learning from adult education (AE) and human resource development (HRD) disciplines and discussed common areas and research gaps. The paper suggested advancing workplace learning theories and building empirical evidence for disadvantaged populations in various workplace contexts through complementary collaboration between AE and HRD.

Apprenticeship training curriculum: examining its negotiated design and the ensuing effects on learner engagement

ABSTRACT This research presents a detailed investigation of Australian apprenticeship training and the VET curriculum which informs its practice. It uses a conceptual framework of curriculum as being intended, enacted, and experienced to structure the research inquiry. It examines apprenticeships within the baking industry and draws on interviews with 23 design participants throughout the curriculum design process. The study draws on theoretical concepts of learning through participation and acquisition to understand the accumulative effects on the apprentice experience and their subsequent levels of engagement. The research findings make several important contributions towards VET theoretical knowledge. First, the study presents a detailed illumination of the vocational curriculum design process from its conception by governments, through to its implementation by college trainers and its ensuant influence over apprentice learners. Second, the study extends existing workplace learning theories of participation by exemplifying participation as an affordance and an act of agency, as an action that is both passive and active. Third, the study’s findings contribute to socio-political and socio-material conceptions of workplace learning relations, where knowledge is situated and shaped through the influence of contexts, actor relations and material artefacts. Together these findings contribute to existing understandings of apprentice dis-engagement and their decision to leave.

Theories of workplace learning in changing times

Theories of workplace learning in changing times

One fidelity fits all? How civil protection simulations afford (or not) improvement opportunities for novice and occasional crisis managers

Novice and occasional crisis managers (NOCM) such as elected officials or public service managers play an essential role in civil protection. Although simulations are an important way of preparing for crisis response , conditions of simulation effectiveness for this target group are under-investigated. Specifically, high-fidelity is generally thought to be a paramount condition for simulation effectiveness. This conviction is regularly doubted in the literature, especially when it comes to novice or occasional practitioners. The aim of this study was to understand how high- and low-fidelity mechanisms in crisis simulations afford improvement opportunities for novice and occasional crisis managers. We video-recorded (i) four participants’ behavior in two contrasting typical high- and low-fidelity simulations, and (ii) four self-confrontation interviews. Using Billett’s theory of workplace learning (2001) combined with the course-of-action framework (Poizat et al., 2022), we analyzed and synthesized high- and low-fidelity simulation conditions with a four-dimension model. Results show that a slow tempo, a clearly stated fictional contract, physical and functional fidelity, a crisis element, and an appropriate pedagogical support tend to afford improvement opportunities for NOCMs. Implications for simulation design and pedagogical support are discussed. We propose an alternative for costly high-fidelity simulations: the “good enough simulation”.

Transforming Biographical Experience Into Occupational Accountability: Paraprofessional Integration Workers’ Efforts to Professionalise Integration Support in Sweden

Integration support is a rather new professional field, and it is common for paraprofessionals (PPs) with personal migration experiences as their main qualification to perform the work without having a job description, education or ethical principles to follow. In previous research, migration experiences have been contested as a professional competence and criticism has been raised about a lack of professionalism. Organisational professionalisation directed from above – such as education, guidelines and standardisation – has been requested. This study raises questions about occupational professionalisation from within, from the working group itself. Based on workplace learning theory, the study explores how a working group of 30 PP integration workers in Civic Orientation are enhancing occupational capacities jointly. They identified a lack of client responsiveness as a problem and developed an explanatory model where their own biographical experience of migration (themselves as former migrants or their family members and recollections of their former ‘home country’) play a crucial role. Thus, the results indicate that one’s own migration experience can be a part of and a motivator for occupational professionalism of PPs if it is allowed to be collectively reflected on, critically scrutinised and contextualised.

Structural Equation Modeling on Nursing Work Performance : Social Exchange and Workplace Learning Theories

Structural Equation Modeling on Nursing Work Performance : Social Exchange and Workplace Learning Theories

Formal and informal learning as deterrents of turnover intentions: Evidence from frontline workers during a crisis

AbstractEmployee learning and development is critical to organizational success, particularly during times of crisis when increased volatility and demand necessitate adaptability and skill. We draw on theories of workplace learning and social exchange to investigate the unique influence of formal training, informal learning, and organizational support for training on the turnover intentions of frontline workers battling COVID‐19. Survey data were gathered from a sample of Direct Support Professionals (N = 481) in New York state who continued their work supporting individuals with developmental and intellectual disabilities during the global coronavirus pandemic. The results support our predictions that employee engagement in formal training and, to a lesser extent, informal learning, as well as individuals’ perceptions of organizational support for training, explain unique variance in turnover intentions. Alternative predictors, including tenure and region, explained some unique variance in turnover intentions, but neither age nor learning goal orientation demonstrated meaningful effects. Relative weights analysis revealed that the strongest negative predictors of turnover intentions were organizational support for training and engagement in formal training. Altogether these findings identify possible methods of deterring turnover intentions, by highlighting the key role that organizations play in supporting continuous learning amongst their employees, even in times of crisis. Implications of this study are discussed for research and practice on workforce learning and development for frontline workers and others, more generally.

The Differential Influence of Learner Factors and Learning Context on Different Professional Learning Activities

Participation in designated learning opportunities and engagement in workplace learning are very different kinds of professional learning activities: Whereas the former takes place in organised, predefined settings with intended learning objectives, the latter mostly arises as a by-product through everyday experiences at work. Yet, empirical and theoretical models often do not sufficiently differentiate between these two kinds of learning activities. The main goal in the present study is to test whether the two discrete learning activities are indeed facilitated in different ways and by different antecedents. The results of a multi-wave diary study with a sample of 229 German employees show that engagement in workplace learning is not influenced by conscious beliefs connected to learning, which play a central role in most theoretical models explaining participation in designated learning opportunities, underlining the need for an autonomous theory of workplace learning. Furthermore, the current study shows the strong direct, indirect, and moderating influence of organisational learning culture on both kinds of professional learning activities. Possible implications for practitioners to put greater emphasis on organisational factors when designing learning opportunities are discussed.

Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic.

IntroductionDuring the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period.MethodsHeld three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors.ResultsTwenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful.DiscussionVR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.

Exploring the professional development of doctoral supervisors through workplace learning: a literature review

ABSTRACT The professional development of doctoral supervisors is a relatively new area of academic development that is still non-existent in many higher education institutions worldwide. This is particularly relevant to explore as several other studies indicate that the quality of doctoral supervision has a direct impact on the doctoral student progression and attrition rates and on the quality of the student experience. The purpose of this literature review is to explore what has been written about the professional development of doctoral supervisors, with a focus on understanding how learning takes place in the workplace. Through a systematic literature review approach, 20 manuscripts in the social sciences were identified as providing an in-depth exploration of the topic under study. The analysis of these manuscripts was situated within the theories of adult and workplace learning. Professional development occurred in different shapes and forms and is shaped by institutional and national academic cultures. There was a common understanding that learning occurred more often through self-reflection and dialogue, in both formal and informal learning spaces, and that there is a need for focusing more on the pedagogy of the doctorate. The article ends by suggesting a set of institutional recommendations for promoting the professional development of supervisors.

First-line managers’ practices and learning in unpredictable work within elderly care

ABSTRACT Despite the number of studies confirming a high degree of unpredictability in managerial work, little is still known about how managers’ workplace learning happens within organisations in such circumstances. This paper therefore aims to contribute knowledge about managers’ learning in managerial practice when work is unpredictable, by investigating how first-line managers deal with unforeseen situations and how they learn in such circumstances in everyday work. Data was collected via qualitative interviews with 40 first-line managers in Swedish elderly care. By using a theoretical framework based on practice and workplace learning theories, the paper analyses how managers address unpredictability in work through three embedded practices: maintaining, modifying and inventing. The paper goes beyond research on leadership training and leadership development by contributing knowledge about the everyday learning of first-line managers when their work is unpredictable. The unpredictable managerial work does not always create chaos; instead, there are very orderly ways of learning from dealing with unforeseen situations. The unforeseen is not as unpredictable as it might seem in managerial work. On the other hand, that which is not yet known calls for an inventing practice, which results in managers learning to take new paths that can create new practices.

Becoming clinical supervisors: identity learnings from aregistrar faculty development program.

This article shares our experiences and surprises as we developed, implemented and evaluated a 12-week faculty development program for registrars as clinical supervisors over three cohorts. The program has consistently been rated highly by participants. Yet, following a comprehensive curriculum review, we were surprised that our goal of encouraging identity development in clinical supervisors seemed to be unmet. Whilst our evaluation suggests that the program made important contributions to the registrars’ knowledge, application and readiness as clinical supervisors, challenges linked to developing a supervisor identity and managing the dual identity of supervisor and clinician remain. In this article we describe our program and argue for the importance of designing faculty development programs to support professional identity formation. We present the findings from our program evaluation and discuss the surprising outcomes and ongoing challenges of developing a cohesive clinical educator identity. Informed by recent evidence and workplace learning theory we critically appraise our program, explain the mechanisms for the unintended outcomes and offer suggestions for improving curricular and pedagogic practices of embedded faculty development programs. A key recommendation is to not only consider identity formation of clinical supervisors from an individualist perspective but also from a social perspective.Supplementary InformationThe online version of this article (10.1007/s40037-020-00642-9) contains supplementary material, which is available to authorized users.

Micro-relational interdependencies are the essence of teaching and learning in the OR.

In the high-stakes, time-critical environment of the operating room (OR), attendings and residents strive to complete safe, effective surgeries and ensure that learning occurs. Yet meaningful resident participation often receives less attention, and that impedes residents' ability to learn and achieve autonomous operative practice. We need a new conceptual framework for understanding progression to autonomous practice that can guide both faculty and residents. Thus, we sought a new conceptualisation of intraoperative teaching and learning (IOT&L) through the lens of Eraut's notion of informal workplace learning and Billett's theory of relational interdependence between social and individual agency. We viewed authentic examples of IOT&L in video and transcripts of live OR cases and interviews with participating attendings and residents. By systematically applying Eraut and Billet's theories to the transcripts and interviews, we developed concrete descriptions about how IOT&L occurs, categorised them into theory-based principles and derived a conceptualisation and related research ideas about IOT&L. Established workplace learning theories frame IOT&L as socially negotiated processes transpiring in distinct interdependent interactions between residents' individual cognitive experiences and their OR social experiences that direct their learning. As the surgery unfolds, spontaneous events and the rules of surgery create opportunities for unplanned and informal learning. These authentic interrelated cognitive and social experiences are stimulated when residents reveal a learning need or attendings recognise a learning gap, and efforts ensue to bridge that gap. Through these minute distinct exchanges, labelled here as 'atomic' IOT&L, residents gain crucial knowledge and skill. Framing authentic OR interactions between attendings and residents in terms of micro-relational interdependencies shows how granular teaching/learning exchanges yield high-value informal learning. To improve IOT&L, we must examine and change it at this fundamental level by using and testing this new theoretical conceptualisation. These insights produced ideas about IOT&L to test and research.

Resident learning trajectories in the workplace: A self-regulated learning analysis.

Research in workplace learning has emphasised trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in intensive care units? In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant comparative methodology to analyse the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitising concepts. We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e. becoming attuned to task-relevant factors), navigating trajectories (i.e. creating and interacting with opportunities to perform procedures), and co-constructing trajectories with their peers, supervisors and interprofessional team members. We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritising certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.

Factors influencing junior doctor workplace engagement in research: An Australian study

Introduction: Engaging junior doctors in research can contribute to improved health outcomes, but there is a lack of guidance on how best to support junior doctor research engagement through their workplace experiences. This study aims to identify factors influencing Australian junior doctors’ workplace engagement in research and inform recommendations for building research capacity. Methods: This qualitative interview study, using convenience sampling, explored junior doctors’ perceptions and experiences of research engagement. Seventeen junior doctors working at an Australian teaching hospital were interviewed. Data were analysed using the framework method, informed by workplace learning theory. Results: Junior doctors found it challenging to engage in research activities and attributed this to the lack of a practice-based curriculum to sequence their learning. They described an absence of workplace affordances for research engagement, including time, research-active clinician mentors and accessible projects. Whilst career progression was one motivator for research engagement, a key motivator was engaging in research contributing to patient care. Conclusions: The findings suggested that absence of practice-based curriculum, mentor guidance and engagement in meaningful research activities hampered research engagement. These findings may inform junior doctor research development programs in acute healthcare organisations.

Developing occupational therapists' capabilities for decision-making capacity assessments: how does asupport role facilitate workplace learning?

IntroductionHealthcare practitioners are required to develop capabilities in an effective and efficient manner. Yet, developing capabilities in healthcare settings can be challenging due to the unpredictable nature of practice and increasing workloads. Unsurprisingly, healthcare practitioner development is often situated outside of practice, for example in formal teaching sessions. Supporting practitioners to develop capabilities through engagement with day-to-day practice, whilst advantageous in terms of authenticity and being highly valued, remains a key challenge for healthcare educators. This qualitative interview study aimed to explain, from the learner’s perspective, how a dedicated support role develops occupational therapists’ capability to contribute to decision-making capacity assessments.MethodsIndividual semi-structured interviews were conducted with a purposive sample of 12 occupational therapists. Informed by workplace learning theory, interview transcripts were analyzed using thematic analysis process.ResultsParticipants provided rich descriptions of how they developed in their capability to engage in decision-making capacity assessments. Participants reported that their learning was facilitated by the dedicated support role in three key ways: 1) structuring a journey of learning, 2) providing tailored guidance, and 3) fostering a supportive learning environment.DiscussionParticipants valued the authentic workplace learning opportunities afforded by the dedicated support role. Findings suggest that capabilities, such as decision-making capacity assessment, can be developed through practice when enriched by a dedicated support role. However, further research examining the sustainability and transferability of this model and its application to other capabilities are warranted.

"It's yours to take": generating learner feedback literacy in the workplace.

Feedback can improve students' learning and performance on clinical placements, yet students are often dissatisfied with the process. Attempts to improve feedback frequently focus on faculty development programs without addressing learners' capabilities to engage with feedback. For feedback to be effective, students need to understand its processes and to translate this into practice. Developing student feedback literacy may enhance feedback engagement and, therefore, learning outcomes. This qualitative interview study aimed to problematise student feedback literacy in the healthcare setting, from the learner's perspective. Before commencing placements, 105 healthcare students at an Australian teaching hospital participated in a feedback literacy program. After their placements, 27 students engaged in semi-structured interviews to explore their feedback experiences. Informed by workplace learning theory, interview transcripts were analysed using the framework method of qualitative analysis. Students reported reframing feedback as a process they could initiate and engage in, rather one they were subjected to. When they took an intentional stance, students noted that feedback conversations generated plans for improvement which they were enacting. However, students had to work hard against orthodox feedback expectations and habits in healthcare. They privileged intraprofessional supervisor feedback over interprofessional practitioners, patients, or peers. Findings suggest that student engagement with feedback can be augmented with focussed retraining. However, further research examining the structural and cultural influences on students' capacity to be active in workplace feedback is warranted.

Conceptualizing Learning Environments in the Health Professions.

The learning environment (LE) is an important and frequently discussed topic in the health professions education literature. However, there is considerable inconsistency in how the LE is defined and described. The authors propose a definition of the LE and a conceptual framework to facilitate health professions educators in understanding, studying, and designing interventions to improve the LE. To arrive at this conceptual framework, the authors employed a living systems perspective that draws on various frameworks and theories, including ecological psychology, workplace learning, situated cognition, and sociomateriality theory. The conceptual framework identifies five overlapping and interactive core components that form two dimensions: the psychosocial dimension and material dimension. The psychosocial dimension comprises three components: the personal, social, and organizational. Intertwined with the psychosocial dimension at each level is the material dimension, which encompasses physical and virtual spaces. This theoretical lens can facilitate identifying and analyzing problems in the LE and guide development of interventions to mitigate them. The authors conclude with several practical suggestions for health professions educators, investigators, and editors.